SAMPLE FORMAT FOR MEMORANDUM OF UNDERSTANDING



BUMEDINST 6300.8

1 Sep 2000

SAMPLE FORMAT

MEMORANDUM OF UNDERSTANDING

BETWEEN A NAVAL MEDICAL FACILITY

AND A CIVILIAN ORGANIZATION

FOR TISSUE DONATIONS

1. General

a. This memorandum of understanding is entered into by (name of civilian hospital) located at (address of civilian hospital) and (name of naval medical facility) located at (address of naval medical facility).

b. The purpose of this Agreement, hereinafter referred to as the MOU, is to assist in identifying Department of Defense (DoD) personnel who are members of the DoD Tissue Donation Program; procuring such members' tissues, following their documented wishes, or the wishes of their next of kin (NOK), upon their demise in a civilian hospital; and making recovered tissues available for transplantation to qualified recipients.

2. Background

a. The need for cadaver tissues is far greater than the available supply. This shortage of transplantable tissues is due in part to the lack of a comprehensive and uniform system that brings potential donors and recipients together.

b. DoD has established a voluntary tissue donor program whereby active duty personnel, retirees, and family members are encouraged and provided assistance in donating their tissues upon their death.

c. The U.S. Army, Navy, or Air Force will provide a tissue procurement team to surgically remove tissues from deceased donor patients who have died in any civilian or military medical facility within 150 miles of the Walter Reed Army Medical Center (WRAMC), Washington, DC.

d. Some naval MTFs can provide a tissue procurement team to surgically remove tissues from deceased donor patients in civilian hospitals outside the 150-mile radius of WRAMC.

Enclosure (5)

BUMEDINST 6300.8

1 Sep 2000

e. Attending physicians, the physician who pronounces the death, and all other health care personnel involved in direct care of a donor patient, are prohibited from participating in tissue procurement or transplantation of donated tissues.

3. Articles of Agreement

a. Definition of Terms

(1) Donor patient is any patient who is a likely candidate to have his or her tissues surgically removed and used for transplantation.

(2) DoD patient is any person who is entitled to use inpatient DoD medical facilities, including but not limited to active duty military members, retirees, and family members of active duty members and retirees.

(3) Recipient is any person who receives transplanted tissues.

(4) DoD recipient is a person who receives transplanted tissues while entitled to use inpatient DoD medical facilities, regardless of site of actual transplantation.

(5) Procurement is the surgical removal of tissues from cadavers.

(6) Procurement team is a group of trained health care professionals authorized to surgically procure cadaver tissues.

(7) Organ procurement organization (OPO) is a civilian organization that provides and coordinates a procurement team to procure organs or tissues at a civilian or military hospital.

(8) DEERS database is a computerized listing of all DoD personnel. The database is being modified to provide a listing of those who have voluntarily agreed to become organ and tissue donors.

(9) Participating hospital is any civilian or military facility that signs an agreement as depicted in this MOU.

Enclosure (5) 2

BUMEDINST 6300.8

1 Sep 2000

b. Participating Civilian Facility's Responsibilities

(1) When a potential donor patient is admitted to a participating civilian organization and is determined by the treating physician to be a donor patient, the organization will make a reasonable and good faith effort to identify the patient's status as a DoD patient.

(2) When it is determined the potential donor is a DoD patient, the civilian organization will then place a telephone call immediately to the procurement team coordinator (PTC) or appropriate staff member at (naval treatment facility) at (telephone number) to determine the tissue donor status of the DoD patient.

(3) Under this MOU, the civilian organization agrees to allow the procurement team reasonable access to all medical equipment and facilities at the facility that are necessary to carry out organ procurement from DoD donor patients.

(4) Participating civilian organizations must document deaths of potential DoD donors and allow DoD representatives reasonable access to DoD patient medical records and facilities to ensure compliance with this MOU.

(5) Participating civilian organizations agree to maintain a record of all DoD patients who are determined by the attending physician to be potential donor patients. The record will describe what action the civilian organization used in attempting to procure the patient's organs. Records of such action must be sent to the naval medical facility negotiating this MOU.

(6) Attending physicians, at civilian organizations, are solely responsible for determining the death of a donor patient following local law and established medical protocol. Such determination must, however, receive the concurrence of at least two other members of the medical staff practicing in different services. Concurrence must be documented in the progress notes of the patient's medical chart.

3 Enclosure (5)

BUMEDINST 6300.8

1 Sep 2000

c. Naval Medical Facilities PTC Responsibilities

(1) When notified a DoD patient in a civilian organization is a potential donor, the PTC must evaluate the potential donor for satisfactory medical criteria for organ or tissue donation by:

(a) Checking DEERS.

(b) Checking the medical records.

(c) Checking other documents.

(2) If there is no indication the patient, before death, expressed wishes not to become a tissue donor, the PTC or attending physician will contact the patient's NOK to discuss the patient's tissue donation decision. Before this action is taken, ensure the NOK has been appropriately apprised of the patient's condition through normal Casualty Assistance Calls Program procedures, reference (f). The discussion may occur before the death of a donor patient. The PTC must counsel the NOK concerning the donor patient's documented desire and make every reasonable effort to obtain consent to donate from the NOK. If the NOK refuses to concur in the patient's desire to donate, procurement efforts must cease.

(3) When notified a patient is a donor patient, the PTC must notify WRAMC at DSN 662-6462 or commercial (202) 782-6462 of the availability of donor tissues. In addition, the PTC must notify the procurement team.

(4) If possible, the PTC or attending physician will arrange with the treating facility to allow access to the procurement team to examine the patient and the patient's medical records before death.

(5) Immediately after death of a potential donor patient, the PTC or attending physician must contact the procurement team (if one exists) for orders concerning cadaver maintenance before procurement. The PTC or attending physician must arrange for procurement and relay information to the participating civilian organization. Proper cadaver maintenance takes precedence over obtaining concurrence for procurement from the NOK or through the Casualty Assistance Calls Program Coordinator.

Enclosure (5) 4

BUMEDINST 6300.8

1 Sep 2000

d. Tissue Usage or Disposition. All tissues from DoD bene-ficiaries must first be made available to DoD transplantation programs, unless the donor has indicated otherwise. If a suitable DoD recipient cannot be located, then the tissues must be made available to civilian transplantation programs.

e. Costs and Reimbursement for Services at Civilian Organizations

(1) If procured tissues of DoD donor patients are trans-planted into a DoD recipient, DoD must reimburse the civilian organization for all reasonable expenses directly related to the cost of cadaver maintenance and tissue procurement. Such expenses as laboratory analysis, drugs, equipment, operating room costs, and similar overhead expenses are considered.

(2) If the procured tissue is not transplanted into a DoD recipient, DoD is not responsible for costs incurred as a result of cadaver maintenance or tissue procurement.

(3) If DoD provides the procurement team for a DoD donor patient at a civilian organization and procured tissues are not transplanted into a DoD recipient; the civilian organization is responsible for the procurement team's reasonable procurement expenses. Reimbursement must be made per NAVCOMPT Manual, Vol. III, article 035875, made payable to the U.S. Treasury, and sent to: (address).

f. Other Considerations

(1) Effective Period. The effective period of this MOU will be from the date signed by both parties and will continue in effect until terminated as specified in paragraph 3f(2) below.

(2) Agreement Termination. Termination of this agreement may be effected by either party to the MOU upon written notice to the other party when deposited in the U.S. mail and directed to the other party.

Both parties have read and agree to comply with all terms and provisions of this MOU.

______________________________________ _________________

Civilian Organization Signer and Title Date

______________________________________ _________________

Naval Hospital Signer and Title Date

5 Enclosure (5)

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